COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health
Open accessAbstract
Most of the global population live in low-income and middle-income countries (LMICs), which have historically received a small fraction of global resources for mental health. The COVID-19 pandemic has spread rapidly in many of these countries. This Review examines the mental health implications of the COVID-19 pandemic in LMICs in four parts. First, we review the emerging literature on the impact of the pandemic on mental health, which shows high rates of psychological distress and early warning signs of an increase in mental health disorders. Second, we assess the responses in different countries, noting the swift and diverse responses to address mental health in some countries, particularly through the development of national COVID-19 response plans for mental health services, implementation of WHO guidance, and deployment of digital platforms, signifying a welcome recognition of the salience of mental health. Third, we consider the opportunity that the pandemic presents to reimagine global mental health, especially through shifting the balance of power from high-income countries to LMICs and from narrow biomedical approaches to community-oriented psychosocial perspectives, in setting priorities for interventions and research. Finally, we present a vision for the concept of building back better the mental health systems in LMICs with a focus on key strategies; notably, fully integrating mental health in plans for universal health coverage, enhancing access to psychosocial interventions through task sharing, leveraging digital technologies for various mental health tasks, eliminating coercion in mental health care, and addressing the needs of neglected populations, such as children and people with substance use disorders. Our recommendations are relevant for the mental health of populations and functioning of health systems in not only LMICs but also high-income countries impacted by the COVID-19 pandemic, with wide disparities in quality of and access to mental health care.
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How much the pandemic will strain health-care systems in the future is uncertain.
“and the pressure of the pandemic on health-care systems in the future.”
From Strengthening public mental health during and after the acute phase of the COVID-19 pandemic (2022) · cites this paper as [5]
It has been the focus of recent calls for a paradigm change in the field of global mental health, particularly in the context of the COVID-19 pandemic.
“It has been the focus of recent calls for a paradigm change in the field of global mental health (106–108), particularly in the context of the COVID-19 pandemic (109).”
From Recovery from Severe Mental Health Problems: A Systematic Review of Service User and Informal Caregiver Perspectives (2021) · cites this paper as [109]
Digital technologies and AI have been proposed as potential solutions to these challenges.
“Digital technologies and Artificial Intelligence (AI) have been proposed as potential solutions to these challenges [Rudd and Beidas, 2020, Taylor et al., 2020, Kola et al., 2021].”
From Closing the accessibility gap to mental health treatment with a personalized self-referral chatbot (2024) · cites this paper as Kola et al., 2021
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“6%, and while the prevalence is rising globally, the late SARS-CoV-2 pandemic caused problems, especially in middle- and low-income countries [3,4].”
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“Research has emerged on impacts from low and middle income countries (Kola et al., 2021), which has shown similarly high rates of mental distress exacerbated by social, economic and cultural factors, particularly poor access to services.”
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“, 2019), particularly in the context of the COVID-19 pandemic (Kola et al., 2021).”
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“Critically, given the immense and unprecedented scale of social disruption caused by the pandemic, mental health interventions need to be responsive to the specific social determinants in each context, especially those exacerbated by COVID-19, in order to achieve their intended impacts [20].”
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“Despite this, mental health issues in young populations were often overlooked [5].”
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Anxiety and Depression: What Do We Know of Neuropeptides?
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“The impact of the pandemic had an amplifying effect on mental health issues among the gener l opulation of low- and middle-income countries [10].”
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A guide to systems-level, participatory, theory-informed implementation research in global health
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A Longitudinal Nationwide Study of Psychological Distress During the COVID-19 Pandemic in Chile
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The effects of COVID-19 lockdown measures on health and healthcare services in Uganda
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Perceived accessibility and mental health consequences of COVID-19 containment policies
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Exercise as an antidepressant: exploring its therapeutic potential
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Digital psychiatry in low-and-middle-income countries: New developments and the way forward
Chakrabarti, S. (2024) · World Journal of Psychiatry · doi:10.5498/wjp.v14.i3.350 · Cited by 46 · see citing works
Liu, Y., Ren, Y., Liu, C., Chen, X., Li, D., Peng, J., Tan, L., & Ma, Q. (2025) · Psychological Medicine · doi:10.1017/s0033291725000649 · Cited by 46 · see citing works
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“[26]), an accurate understanding of the interactions between personality characteristics and mental functioning abilities involved in poorly adaptive reactions to the pandemic has important implications for the development of effective mental health interventions [95].”
BackgroundVillarreal‐Zegarra, D., Paredes-Ángeles, R., Mayo‐Puchoc, N., Arenas-Minaya, E., Huarcaya-Victoria, J., & Copez-Lonzoy, A. J. E. (2024) · BMC Psychology · doi:10.1186/s40359-024-01688-8 · Cited by 44 · see citing works
“Evidence indicates that the mental health impacts (e.g., anxiety, depression, posttraumatic stress) caused by strict health measures in low-income and middle-income countries have a significant mental impact, which contributes to a slow recovery toward normality [34].”
BackgroundForecasting suicide rates in India: An empirical exposition
Swain, P. K., Tripathy, M. R., Priyadarshini, S., & Acharya, S. K. (2021) · PLoS ONE · doi:10.1371/journal.pone.0255342 · Cited by 44 · see citing works
Psychological distress, low-income, and socio-economic vulnerability in the COVID-19 pandemic
Santana, C. L. A., Manfrinato, C. V., Souza, P. R. P., Marino, A., Condé, V. F., Stedefeldt, E., Tomita, L. Y., & do Carmo Franco, M. (2021) · Public Health · doi:10.1016/j.puhe.2021.08.016 · Cited by 60 · see citing works
Steeg, S., John, A. M., Gunnell, D., Kapur, N., Dekel, D., Schmidt, L., Knipe, D. W., Arensman, E., Hawton, K. E., Higgins, J. P. T., et al. (2022) · The British Journal of Psychiatry · doi:10.1192/bjp.2022.79 · Cited by 44 · see citing works
Robinson, T., Condell, J. V., Ramsey, E., & Leavey, G. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20032636 · Cited by 45 · see citing works
“However, there is encouraging evidence to support the implementation of digital, telehealth and faceto-face services tailored to individual needs, thereby improving access to mental health services while also promoting the use of self-management tools, thus potentially reducing burden on such services [1,11,20].”
BackgroundCOVID-19 and mental health in 8 low- and middle-income countries: A prospective cohort study
Aksünger, N., Vernot, C., Littman, R., Voors, M. J., Meriggi, N. F., Abajobir, A. A., Beber, B., Dai, K., Egger, D. T., Islam, A., et al. (2023) · PLoS Medicine · doi:10.1371/journal.pmed.1004081 · Cited by 43 · see citing works
“pre-COVID-19 period data also make it more challenging to track changes in the prevalence of mental health problems in LMICs post-pandemic [19,20].”
BackgroundPurgato, M., Singh, R. K., Acartürk, C., & Cuijpers, P. J. (2021) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796021000500 · Cited by 43 · see citing works
Trends and disparities in non-communicable diseases in the Western Pacific region
Peng, W. H., Zhang, L., Wen, F., Tang, X., Zeng, L., Chen, J., Galea, G., Wen, D., & Wang, Y. (2023) · The Lancet Regional Health - Western Pacific · doi:10.1016/j.lanwpc.2023.100938 · Cited by 46 · see citing works
“13 The universal increased disease burden due to mental disorders in this region was consistent with the global trends, which had an increased proportion of disability-adjusted life years (DALYs) from 3.1% in 1990 to 4.9% in 2019.”
BackgroundInfluentialStrengthening public mental health during and after the acute phase of the COVID-19 pandemic
Kola, L., Kumar, M., Kohrt, B. A., Fatodu, T., Olayemi, B. A., & Adefolarin, A. O. (2022) · The Lancet · doi:10.1016/s0140-6736(22)00523-2 · Cited by 40 · see citing works
Self-citationRahiem, M. D. H., Krauss, S. E., & Ersing, R. L. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph181910489 · Cited by 44 · see citing works
Mental Health and the City in the Post-COVID-19 Era
Bil, J. S., Buława, B., & Świerzawski, J. (2021) · Sustainability · doi:10.3390/su13147533 · Cited by 41 · see citing works
“The pandemic and its consequences for mental health on various populations have shown enormous disproportions in both possibilities of provision of care, as well as in rising concerns about its accessibility [26,36].”
BackgroundKeynejad, R. C., Spagnolo, J., & Thornicroft, G. (2022) · Evidence-Based Mental Health · doi:10.1136/ebmental-2021-300401 · Cited by 43 · see citing works
Self-citationParental mental health and child anxiety during the COVID‐19 pandemic in Latin America
Brik, A. B., Williams, N. A., Esteinou, R., Acero, I. D. M., Mesurado, B., Debeljuh, P., Storópoli, J., Orellana, O. N., & James, S. L. (2022) · Journal of Social Issues · doi:10.1111/josi.12523 · Cited by 43 · see citing works
“Coordinated mental health and psychosocial support services need to be integrated into the pandemic response within LMICs currently and after the pandemic subsides to help ameliorate negative outcomes (Kola et al., 2021).”
BackgroundKruk, M. E., Kapoor, N. R., Lewis, T. P., Arsenault, C., Boutsikari, E. C., Breda, J., Carai, S., Croke, K. G., Dayalu, R., Fink, G., et al. (2023) · The Lancet Global Health · doi:10.1016/s2214-109x(23)00499-0 · Cited by 41 · see citing works
van Rensburg, A. J., & Brooke‐Sumner, C. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.10 · Cited by 39 · see citing works
“, 2011a, 2011b, 2011c; Plagerson, 2015) all of which have been hampered by the impact of COVID-19 (Kola et al., 2021).”
BackgroundFinancial Distress and Psychological Well-Being During the COVID-19 Pandemic
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Kohrt, B. A., Pedersen, G. A., Schafer, A., Carswell, K., Rupp, F., Jordans, M. J. D., West, E., Akellot, J., Collins, P. Y., Contreras, C. C., et al. (2024) · The Lancet Psychiatry · doi:10.1016/s2215-0366(24)00183-4 · Cited by 48 · see citing works
Self-citationRefugee Mental Health, Global Health Policy, and the Syrian Crisis
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Duncan, F., Baskin, C., McGrath, M., Coker, J. F., Lee, C. Y., Dykxhoorn, J. L., Adams, E. A., Gnani, S., Lafortune, L., Kirkbride, J. B., et al. (2021) · BMC Public Health · doi:10.1186/s12889-021-11741-5 · Cited by 38 · see citing works
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“As shown in the literature, many young people suffered psychological pressure, depression, and family and relationship anxieties, along with serious economic worries due to the pandemic [32,33].”
BackgroundSociocultural considerations of mental health care and help-seeking in Uganda
Asiimwe, R., Nuwagaba, R., Dwanyen, L., & Kasujja, R. (2023) · SSM - Mental Health · doi:10.1016/j.ssmmh.2023.100232 · Cited by 37 · see citing works
Field Effect Transistor Biosensors for Healthcare Monitoring (4/2024)
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Informe mundial sobre la salud mental: Transformar la salud mental para todos
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Physical activity for public health in the 21st century
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“Given that cardiometabolic disease, infectious disease, cancer and mental health issues disproportionately burden LMICs 62–64 , increasing access to physical activity for health and wellbeing globally, but especially in LMICs, has the potential to help tackle pervasive global health disparities.”
Scaling up community-delivered mental health support and care: A landscape analysis
Siddiqui, S., Morris, A., Ikeda, D. J., Balsari, S., Blanke, L., Pearsall, M., Rodriguez, R., Saxena, S., Miller, B. F., Patel, V., et al. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.992222 · Cited by 38 · see citing works
Self-citationGlobal mental health and its social determinants: How should we intervene?
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“This approach has become even more relevant in the COVID era, which has amplified the effects of known social determinants of mental health globally (Kola et al., 2021).”
Background
- Authors
- Kola, L., Kohrt, B. A., Hanlon, C., Naslund, J. A., Sikander, S., Balaji, M., Benjet, C., Cheung, E. Y. L., Eaton, J., Gonsalves, P., Hailemariam, M., Luitel, N. P., Machado, D. B., Misganaw, E., Omigbodun, O., Roberts, T., Salisbury, T. T., Shidhaye, R., Sunkel, C., Ugo, V., van Rensburg, A. J., Gureje, O., Pathare, S., Saxena, S., Thornicroft, G., & Patel, V.
- Affiliations
- University of Ibadan (NG)
- George Washington University (US)
- King's College London (GB)
- Harvard University (US)
- University of Liverpool (GB)
- Sangath (IN)
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (MX)
- International Federation of Red Cross and Red Crescent Societies (CH)
- University of Sussex (GB)
- Michigan State University (US)
- Pravara Institute of Medical Sciences (IN)
- Corresponding author
- Kola, Lola
- ORCID
- Kola, Lola
- Kohrt, Brandon A
- Hanlon, Charlotte
- Naslund, John A
- Sikander, Siham
- Balaji, Madhumitha
- Benjet, Corina
- Cheung, Eliza Yee Lai
- Eaton, Julian
- Gonsalves, Pattie
- Hailemariam, Maji
- Luitel, Nagendra P
- Machado, Daiane B
- Misganaw, Eleni
- Omigbodun, Olayinka
- Roberts, Tessa
- Salisbury, Tatiana Taylor
- Shidhaye, Rahul
- Sunkel, Charlene
- Ugo, Victor
- Gureje, Oye
- Pathare, Soumitra
- Saxena, Shekhar
- Thornicroft, Graham
- Patel, Vikram
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2021-06
- Volume
- 8
- Issue
- 6
- Pages
- 535-550
- ISSN
- 2215-0366 (ISSN-L)
- PMC
- PMC9764935
- OpenAlex
- W3129779558
- Cited by
- 835
- References
- 147
- Citations by year
- 2026: 71 · 2025: 108 · 2024: 148 · 2023: 199 · 2022: 207 · 2021: 99 · 2020: 2 · 2014: 1
- FWCI
- 21.75
- Type
- journal article
- Language
- en
- Update notices
- erratum (2021-05-01)
- Open access
- bronze
- doi.org
- Licence
- Locations
- The Lancet Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Arca - Repositório Institucional da Fiocruz (submittedVersion, other-oa)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
- Funders
- Wellcome Trust
- National Institutes of Health (5u19mh113211-05)
- Economic and Social Research Council (ES/T007125/1)
- National Institute of Mental Health (R01MH120649, U19 MH-113211, R01MH100470, R01MH127767)
- Fogarty International Center (K43TW011046)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- COVID-19 pandemic, mental health, low- and middle-income countries, psychological distress, mental health services, global mental health, universal health coverage, task sharing, digital mental health, coercion in mental health care, child mental health, substance use disorders, psychosocial interventions, mental health system strengthening
- MeSH terms
- COVID-19, Developing Countries, Health Promotion, Health Services Accessibility, Humans, Mental Health, Mental Health Services, Socioeconomic Factors, Global Health, Telemedicine, Social Determinants of Health
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